In recent years many European countries have set up national programmes for the implementation of specialist and non-specialist palliative care services but there are still too many patients who do not receive adequate care. Education is the key to improving this situation and must be directed to all relevant professional groups (doctors, nurses, social workers, psychologists and rehabilitation staff) and be included at both a pre-registration or undergraduate level and post-registration. There is an urgent need for collaboration and harmonisation at a European level to exploit the expertise and experience of countries where palliative care is well established and avoid duplication of effort or reinventing the wheel.

In palliative care, there are still sometimes major differences in the approach to the management of common clinical problems. The differences reflect the relative lack of evidence which underpins much clinical practice in this area of healthcare and thus many controversial issues remain unresolved. For this reason the Research Steering Committee (RSC) of the EAPC has organised expert working groups on such topics. Pain is still one of the most common symptoms for which patients are referred to palliative care services. One of the EAPC working groups which has now published two sets of recommendations has focussed on clinical practice with opioid analgesics (BMJ 1996; 312: 823-826; British Journal of Cancer 2001; 84: 587593). The usefulness of this approach which attempts to achieve a consensus on a European level and to develop practical clinical guidelines which can be applicable in different countries and different environments has never formally been evaluated. In this symposium we shall review some of the issues relating to harmonising a European approach to palliative care.